Gunasekaran, K (2010) A study of Peripheral Neuropathy in HIV infected patients. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
INTRODUCTION: The life expectancy of HIV-infected patients has increased as a result of highly active antiretroviral therapy (HAART). Consequently, patients and physicians are dealing with neurologic complications from the HIV disease, from concurrent diseases, and from drugs used to treat it. Peripheral neuropathy is the most common HIV-associated neurologic complication. The spectrum and the frequency of this complication are changing due to introduction of new antiretroviral drugs, an aging HIV-infected population, and the emergence of other long-term complications of HIV and/or its treatment. Several forms of neuropathy may occur, depending on the level of immunosuppression and the presence of risk factors. There is a great need for an improved understanding of these complications and their pathogenetic mechanisms, for the development of effective therapies that provide adequate symptomatic relief and halt or reverse the damage to the nerves. This work of dissertation has been done with an aim of estimating the prevalence and evaluating the risk factors associated with peripheral neuropathy in HIV infected patients of our region. AIMS OF THE STUDY: 1. To study the prevalence of peripheral neuropathy in HIV infected patients. 2. To study the risk factors associated with the development of peripheral neuropathy in HIV infected patients. 3. To study the clinical profile and various types and patterns of peripheral neuropathy in HIV infected patients. 39 MATERIALS AND METHODS: Study Design: This study is a cross sectional study. Study period This study was conducted during the period from January 2009 to December 2009, for 1 year. This Study was done in the Department of Neurology, Tirunelveli Medical College Hospital, Tirunelveli. Patient Selection: Patients attending the out patient department of Anti Retroviral Therapy (ART) Centre at Tirunelveli Medical College Hospital, Tirunelveli were taken for the study. Patients already diagnosed as HIV positive and on Highly Active Anti Retroviral Therapy (HAART) only were selected for the study. Both male and female patients were taken for the study. Study was done with the consent of the patients. Inclusion criteria: 1. Patients who were seropositive for HIV infection and registered with ART centre of Tirunelveli Medical College Hospital. 2. Patients on HAART. 3. Both symptomatic and asymptomatic patients. 4. Patients were selected irrespective of stage of the disease, CD4 count and duration of the HIV illness. Exclusion criteria: 1. HIV seropositive patients who were not on HAART at the time of the study. 2. Patients with other systemic illness like diabetes mellitus, renal disease, thyroid disease, nutritional anaemia, Hansen’s disease. 3. History suggestive of collagen vascular diseases, recent Chikunkunya fever or any other viral illness or jaundice. 4. Patients who regularly consume alcohol of > 40 units/week. SUMMARY: 1. Prevalence of peripheral neuropathy in HIV infected patients in our study is 26/60 (43.3%). 2. In our study, peripheral neuropathy is seen more in patients with advanced clinical stage and increasing age. There is no increase in prevalence of peripheral neuropathy in patients with less CD4 count. But these observations, except the age of the patients, are not statistically significant. 3. Peripheral neuropathy less commonly seen in patients on HAART of longer duration. As duration of HAART increases, peripheral neuropathy is seen more in stavudine users, suggesting drug toxicity is the cause for peripheral neuropathy rather than HIV-related. But this needs to be confirmed with neuropathological studies. 4. Distal symmetrical polyneuropathy is the common type (20/26). Common pathological pattern of neuropathy is mixed (both axonal and demyelination) neuropathy (18/26). 5. All patients who had symptoms of peripheral neuropathy had electrophysiological evidence of peripheral neuropathy. Likewise all patients with signs of peripheral neuropathy had electrophysiological evidence of peripheral neuropathy. Hence detailed history and clinical examination for symptoms and signs of peripheral neuropathy is essential in all HIV infected patients as it can pick up more number of patients with peripheral neuropathy earlier and so they can be treated earlier. 6. Among the 5 patients (who didn’t have either symptoms or sings of peripheral neuropathy) who underwent nerve conduction study, 1 had electrophysiological evidence of peripheral neuropathy. So subclinical peripheral neuropathy present in 20% (1/5) of patients. But this needs to be evaluated with large number of patients. 7. Numbness and tingling were the common and burning pain and pins and needles sensations were the less common symptoms seen in our patients. Diminished or absent ankle jerks, impaired vibration, touch, pain and temperature were the common signs. 8. Symptoms and signs were more common in lower limbs than in upper limbs.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Peripheral Neuropathy, HIV infected patients. |
| Subjects: | MEDICAL > Neurology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 03 Jul 2017 08:34 |
| Last Modified: | 12 Feb 2020 03:04 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/805 |
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